CPC studies link neighborhood characteristics to obesity, other health outcomes

Obesity is one of the most pressing global population health issues, and importantly one that affects race/ethnic minorities and those of low socioeconomic status disproportionately. Each day, we learn more and more about the complex relationships between biologic, socioeconomic, demographic, environmental and cultural factors operating over the course of a person’s life that ultimately influence obesity across populations.

While obesity is strongly related to socioeconomic status (SES), there are complex linkages between social and economic factors that operate over the life course. Penny Gordon-Larsen studies these linkages. Her recent work has illustrated the complexity in defining socioeconomic status over transitional periods of the life course, such as the transition from adolescence to young adulthood.

In three recent papers, one forthcoming in Demography, one in Social Science and Medicine, and the other in the Journal of Epidemiology and Community Health, Gordon-Larsen and colleagues tackled this complex issue, laying the groundwork for future research aimed at understanding the effects of SES on obesity over the life course.

Yet obesity is influenced by broader social, geographic and environment factors as well. Think about the neighborhood where you live. Are there parks or playgrounds in the neighborhood? Are there sidewalks for leisurely strolls or bike lanes for safe biking? Is there a gym or YMCA nearby?

Answers to these questions can influence whether you are more or less physically active than someone in a different neighborhood. Being less physically active can increase your risk of being overweight, developing cardiovascular disease, or having other health issues.

Research has shown that whether a person lives in a rural, urban or suburban area, the neighborhoods around a person’s home can influence how healthy – or unhealthy – he or she is.

Gordon-Larsen studies how neighborhood characteristics impact health outcomes. Her interest in this topic developed from her dissertation on “the ecology of obesity” which focused on how adolescents living in inner city Philadelphia were influenced by their surroundings.

She evaluated whether their diet and physical activity patterns led to weight gain by identifying where restaurants, playgrounds, and other recreation facilities were located. She determined that, for obese and non-obese girls, their diets were often similar but physical activity patterns differed. In areas where there were fewer recreation facilities, obesity rates were higher.

Intrigued by these findings, she wanted to broaden the concept of the study to the national level. However, there wasn’t a dataset that combined detailed information about both neighborhood contexts and the individuals who lived in them. So Gordon-Larsen and several colleagues developed specialized advanced methodologies to integrate rich, objective built, social, and economic environment data from secondary (external) sources, geographically and temporally linked to respondents’ residential addresses spanning a significant portion of the geographic United States.

“This was an immense undertaking and really is one of the first datasets of its kind,” Gordon-Larsen said. She is a Carolina Population Center (CPC) Faculty Fellow and UNC-Chapel Hill Associate Professor of Nutrition. She collaborates with Barry M. Popkin and David K. Guilkey who are CPC Faculty Fellows as well.

Together, they have a series of papers in process that use a structural equations modeling approach to measure the impact of physical activity on obesity, and ultimately health, taking into account residential selectivity bias, a crucial step forward in the assessment of place, space, and health. Initial findings suggest that in the adolescent to young adulthood transition, biases related to residential stability may be at least as strong as residential relocation: those remaining in the parent’s home may do so for reasons also associated with health behaviors (e.g., care for young children, inability to find employment, or attendance at a local college).

The first paper from this series was published in Psychology of Sport and Exercise. This study resulted from the CPC projects Obesity & the Environment: The Transition to Adulthood and Physical Environment Dynamics, Inequality and Obesity. They are funded by the Population Dynamics Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Staff from CPC’s Spatial Analysis Unit was instrumental in developing this dataset. They assembled thousands of variables to create a database that could be analyzed.

Using this new complex dataset, Gordon-Larsen evaluated the relationship between residential location and access to recreational facilities and how this impacted physical activity and overweight patterns. Her work in this area includes a paper in Pediatrics presenting the first empirical evidence that recreational facilities are inequitably allocated across social and geographic space and that these differences translated to differences in physical activity and obesity. This work led to a methods paper published in Annals of Epidemiology.

Gordon-Larsen uses an interdisciplinary approach to her research by working with economists, sociologists, geneticists and human biologists. “I am really interested in integrated approaches to understanding health outcomes, particularly those related to obesity,” she said. “All of my work can be characterized by taking an interdisciplinary and biosocial approach to health. That is what I love about CPC, the ability to interact with so many exceptional researchers who have so many things to add to this work.”

She is very interested in unique methodological approaches to modeling obesity and its determinants. For example, she has used sibling designs to control for confounding associated with the self-selection of parental behaviors in parent-offspring relationships (Epidemiology 2005), interval regression to model timing of obesity (Obesity 2007), and paired analyses to look at romantic partnership, shared household environments and obesity risk (Obesity 2009).

Additionally, she and her collaborators, including CPC Faculty Fellow Linda S. Adair, are beginning to study the role of genetics in shaping a person’s health. “As a human biologist, I am interested in the intersection between biological and social factors. I want to look at how genes and environment interact and work together to influence obesity,” she said.

Determining whether people are susceptible to different aspects of the environment may lead researchers to new knowledge about treating and preventing obesity and other complex diseases. Interdisciplinary approaches and cutting edge methodologies, typical of the work undertaken at the CPC, play a critical role in understanding the complex relationships between biologic, socioeconomic, demographic, and cultural factors operating over the life course.

Sources:

Boone J, Gordon-Larsen P, Stewart JD, Popkin BM. (2008) Validation of a GIS Facilities Database: Quantification and Implications of Error. Annals of Epidemiology 18(5):371-7. PMCID: PMC2430044

Boone-Heinonen JE, Gordon-Larsen P, Guilkey D, Jacobs DR, Jr., Popkin BM. (2011) Environment and Physical Activity Dynamics: The Role of Residential Self-Selection. Psychology of Sport and Exercise 12(1):54-60. PMCID: PMC3079234

Gordon-Larsen P, Adair LS, Suchindran CM. (2007) Maternal Obesity is Associated with Younger Age at Obesity Onset in US Adolescent Offspring Followed into Adulthood. Obesity 15(11): 2790-6.

Gordon-Larsen, P, Nelson, MC, Page, PH, Popkin, BM. (2006) Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity. Pediatrics 117(2): 417-24.

Nelson MC, Gordon-Larsen P, Adair LS. (2005) Are Adolescents Who Were Breast-Fed Less Likely to Be Overweight? Epidemiology 16(2):247-53.

Scharoun-Lee, Adair LS, Kaufman JS, Gordon-Larsen P. (2009) Obesity, Race/ethnicity and the Multiple Dimensions of Socioeconomic Status during the Transition to Adulthood: A Factor Analysis Approach. Social Science & Medicine 68(4):708-16. PMCID: PMC2755235

Scharoun-Lee M, Gordon-Larsen P, Adair LS, Popkin BM, Kaufman JS, Suchindran CM. (2011) Intergenerational Profiles of Socioeconomic (Dis)Advantage and Obesity during the Transition to Adulthood. Demography. 48(2): 625-51.

Scharoun-Lee M, Kaufman JS, Popkin BM, Gordon-Larsen P. (2009) Obesity, Race/ethnicity and Life Course Socioeconomic Status across the Transition from Adolescence to Adulthood. Journal of Epidemiology and Community Health. 63(2):133-9. PMCID: PMC2627789

The NS, Gordon-Larsen P. (2009) Entry Into Romantic Partnership Is Associated with Obesity. Obesity 17(7):1441-7.